Covid-19 Screening - Sousa Ready Mix

Name *

First

Last

Are you fully vaccinated against COVID-19? *

yes
no

In the last 5 days, have you experienced any of these symptoms? *

Select “None of the above” if you have already completed your isolation period of 5 days, and you don't have a fever, and your symptoms have been improving for over 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea).

In the last 14 days, have you travelled outside of Canada and been told to quarantine (per the federal quarantine requirements)? *

yes
no

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *

yes
no

In the last 5 days, have you tested positive for COVID-19? *

yes
no

Do any of the following apply? *

You live with someone who is currently isolating because of a positive COVID-19 test
You live with someone who is currently isolating because of COVID-19 symptoms
You live with someone who is waiting for COVID-19 test results
No

Select “No” if you completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test).

In the past 5 days, have you been identified as a “close contact” of someone who currently has COVID-19 or has symptoms of COVID-19? *

yes
no

Select “No” if you are fully vaccinated, not immunocompromised, and you do not live with the person who has COVID-19, and/or you completed your isolation after testing positive in the last 90 days (using a rapid antigen, rapid molecular, or PCR test).